褐色細胞腫類似の好酸性大型細胞からなる甲状腺髄様癌の１例　細胞病理学的特徴および細胞増殖能について

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  • A case report of medullary thyroid carcinoma resembling pheochromocytoma. Cell pathology and proliferative activity.
  • cell pathology and proliferative activity
  • 細胞病理学的特徴および細胞増殖能について

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A case of medullary thyroid carcinoma resembling a pheochromocytoma is presented with its cytology, histopathology, immunohistochemistry, electron microscopy and proliferative activity using proliferating cell nuclear antigen (PCNA).<BR>A 65-year-old female was found to have elevated serum calcitonin and CEA. Physical examination and CT scanning revealed a left thyroid tumor. A total thyroidectomy was performed. Grossly, the tumor was solid, firm, non-encapsulated but relatively well-circumscribed and measured about 1.5×1.3cm in size. Imprint cytology showed a pleomorphic cell population with granular cytoplasm scattered diffusely or arranged in small clusters. Histologically, the tumor was composed of round to polygonal cells with abundant eosinophilic granular cytoplasm arranged in trabecular and nesting patterns (thus simulating a pheochromocytoma). The tumor cells had many argyrophilic granules in their cytoplasms with Grimelius staining. Immunohistochemical staining by the ABC method demonstrated that the cells were positive for calcitonin, CEA, NSE and keratin. Ultrastructurally, numerous cytoplasmic electrondense round secretory granules, about 200-500 nm in diameter, and abundant mitochondria were present. The percentage of PCNA positive cells was about 50%. This rate was between those of undifferentiated carcinoma and well differentiated papillary or follicular carcinoma of the thyroid gland.<BR>The present case of medullary carcinoma was very similar to a pheochromocytoma cytopathologically. We conclude that immunohistochemical staining for calcitonin is useful for diagnosing medullary thyroid carcinoma.

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